Question 1

Is breaking the nasal bones (osteotomies) always necessary during rhinoplasty?

Accepted Answer

Dr. Guida states that breaking the nasal bones, or osteotomies, is an essential and safe part of rhinoplasty, necessary 95% of the time. This is crucial for centering the nose, especially with a nasal fracture, and for preventing an 'open roof deformity' (a flat, wide nasal bridge) after bump removal, which would require revision surgery. He emphasizes that osteotomies are likely needed for the best cosmetic result.

Question 2

What type of graft material does Dr. Guida use for revision rhinoplasty?

Accepted Answer

For revision rhinoplasty, Dr. Guida's practice utilizes irradiated cadaver rib allograft (cadaver rib cartilage graft). This material is chosen for its straightness and strength, which helps provide adequate tip support and achieve both cosmetic and functional results.

Question 3

What are Dr. Guida's instructions for post-rhinoplasty nose taping?

Accepted Answer

Dr. Guida provides nose taping instructions around eight days after extensive rhinoplasty, septoplasty, and nasal reconstruction surgery. Taping for a few hours daily over the first month helps reduce and contain natural postoperative swelling, supports the nose, and aids healing. The first piece of tape should be placed above the tip, not on it, and then other pieces are applied, overlapping and pinched. He recommends using hypoallergenic medical-grade paper tape, available in drugstores. The best time of day for taping is whatever is most convenient for the patient. Patients should expect their nose to feel stiff and swollen about a week or eight days post-surgery.

Question 4

What is a deviated septum, and how is it diagnosed and treated by Dr. Guida?

Accepted Answer

A deviated septum is a partition separating the nostrils that is sharply angulated, which can cause nasal obstruction and chronic sinusitis. If a deviated septum is suspected, Dr. Guida recommends seeing an ENT doctor and getting a CAT scan of the nose and paranasal sinuses, as this computerized X-ray provides detailed anatomy to diagnose the exact issue. If necessary, there is a very successful surgical procedure to fix the septum, leading to a straight septum, open airway, better breathing, and improved sinus drainage.

Question 5

What is chronic sinusitis, what are its risks, and how is it treated by Dr. Guida?

Accepted Answer

Chronic sinusitis is a recurrent infection or inflammation of the air pockets within the skull, characterized by episodes happening over weeks or months. Mucus can become trapped due to obstructions like polyps or a deviated septum, leading to infection. If left untreated, chronic sinusitis can be life-threatening, potentially leading to severe complications such as large polyps pressing on the eyeball, infection spreading to the eye (with potential for blindness), or even to the brain, causing meningitis which can be fatal. Dr. Guida emphasizes that chronic sinusitis should not be ignored. Treatment typically begins with antibiotic therapy. If antibiotics are ineffective, endoscopic sinus surgery is indicated to clean up the infection and resolve related issues, such as those affecting the eye.

Question 6

What are the effects of cocaine use on the nose, and can the damage be repaired?

Accepted Answer

Cocaine acts as a vasoconstrictor, constricting blood vessels and leading to a lack of nourishment to the nasal skin. Prolonged and excessive intranasal cocaine use can cause the bone and cartilage in the nose to melt, resulting in severe septal perforations and tissue necrosis. This damage often requires extensive reconstructive surgery, including rib grafting to rebuild the nasal dorsum and surgical repair of septal perforations. Dr. Guida emphasizes that excessive intranasal cocaine use can cause serious, even life-threatening problems.

Question 7

What is a tipplasty, and what is Dr. Guida's approach to it?

Accepted Answer

Tipplasty is a surgical procedure performed solely on the tip of the nose, without affecting the upper two-thirds. Dr. Guida performs tipplasty for patients with concerns such as a very bulbous or wide tip, an over-projected tip, wide nostrils, or a nasal tip that is getting wider with age and lacks definition. The procedure involves refining or defining tip cartilages to create a more narrow, refined, and triangular look. He emphasizes that a tipplasty must be carefully planned and cosmetically balanced with the upper two-thirds of the nose to achieve a natural look that fits the patient's face better. During consultation, digital images are taken and altered on a computer to show patients the possible outcomes.

Question 8

How can I prevent nosebleeds and discomfort caused by dry winter air?

Accepted Answer

Dry winter air, especially in places like New York City and heated apartments, can lead to nosebleeds and discomfort. Dr. Guida recommends several measures: using a simple saline nasal spray two or three times a day, using a humidifier in your apartment to keep the air moist, and taking steam showers or sitting in a steam room two or three times a week. He advises against using a neti pot or aggressive water pick irrigation. Most importantly, he stresses hydration, recommending drinking six to eight glasses of water daily for overall and nasal health.

Question 9

Why is cadaver rib cartilage used for revision rhinoplasty instead of a patient's own cartilage, and what are the pros/cons?

Accepted Answer

For revision rhinoplasty, Dr. Guida's practice utilizes irradiated cadaver rib allograft (cadaver rib cartilage graft). This material is chosen for its straightness and strength, which helps provide adequate tip support and achieve both cosmetic and functional results.

Question 10

Is breaking the bones always necessary for rhinoplasty, or are there alternatives for subtle changes?

Accepted Answer

Dr. Guida states that breaking the nasal bones, or osteotomies, is an essential and safe part of rhinoplasty, necessary 95% of the time. This is crucial for centering the nose, especially with a nasal fracture, and for preventing an 'open roof deformity' (a flat, wide nasal bridge) after bump removal, which would require revision surgery. He emphasizes that osteotomies are likely needed for the best cosmetic result.

Question 11

What are the long-term health risks if chronic sinusitis is left untreated?

Accepted Answer

Chronic sinusitis is a recurrent infection or inflammation of the air pockets within the skull, characterized by episodes happening over weeks or months. Mucus can become trapped due to obstructions like polyps or a deviated septum, leading to infection. If left untreated, chronic sinusitis can be life-threatening, potentially leading to severe complications such as large polyps pressing on the eyeball, infection spreading to the eye (with potential for blindness), or even to the brain, causing meningitis which can be fatal. Dr. Guida emphasizes that chronic sinusitis should not be ignored. Treatment typically begins with antibiotic therapy. If antibiotics are ineffective, endoscopic sinus surgery is indicated to clean up the infection and resolve related issues, such as those affecting the eye.

Question 12

Can a nose damaged by cocaine use be fully repaired, and what does the reconstruction process typically involve?

Accepted Answer

Cocaine acts as a vasoconstrictor, constricting blood vessels and leading to a lack of nourishment to the nasal skin. Prolonged and excessive intranasal cocaine use can cause the bone and cartilage in the nose to melt, resulting in severe septal perforations and tissue necrosis. This damage often requires extensive reconstructive surgery, including rib grafting to rebuild the nasal dorsum and surgical repair of septal perforations. Dr. Guida emphasizes that excessive intranasal cocaine use can cause serious, even life-threatening problems.

Question 13

How long after rhinoplasty should I continue nose taping, and is there a specific type of tape recommended?

Accepted Answer

Dr. Guida provides nose taping instructions around eight days after extensive rhinoplasty, septoplasty, and nasal reconstruction surgery. Taping for a few hours daily over the first month helps reduce and contain natural postoperative swelling, supports the nose, and aids healing. The first piece of tape should be placed above the tip, not on it, and then other pieces are applied, overlapping and pinched. He recommends using hypoallergenic medical-grade paper tape, available in drugstores. The best time of day for taping is whatever is most convenient for the patient. Patients should expect their nose to feel stiff and swollen about a week or eight days post-surgery.

Question 14

Is tip-plasty a less invasive procedure than a full rhinoplasty, and what is the typical recovery time?

Accepted Answer

Tipplasty is a surgical procedure performed solely on the tip of the nose, without affecting the upper two-thirds. Dr. Guida performs tipplasty for patients with concerns such as a very bulbous or wide tip, an over-projected tip, wide nostrils, or a nasal tip that is getting wider with age and lacks definition. The procedure involves refining or defining tip cartilages to create a more narrow, refined, and triangular look. He emphasizes that a tipplasty must be carefully planned and cosmetically balanced with the upper two-thirds of the nose to achieve a natural look that fits the patient's face better. During consultation, digital images are taken and altered on a computer to show patients the possible outcomes.

Question 15

What does Dr. Guida say about their techniques?

Accepted Answer

In a case like this, we had to use rib grafting to reconstruct the nasal dorsum. Septal perforations caused by excessive cocaine use require surgical repair. We did work to show that the tip cartridges can be more refined or defined.

Question 16

What does Dr. Guida say about the technology they use?

Accepted Answer

We take digital images, we put it on the computer, and we can alter the images on the computer so we can see what the possibilities are.

Question 17

What does Dr. Guida say about what they specialize in?

Accepted Answer

Dr. Robert Guida is considered NYC’s best rhinoplasty and sinus surgeon.

Question 18

What does Dr. Guida say about their training and credentials?

Accepted Answer

Dr. Robert Guida is an NYC facial plastic surgeon and rhinoplasty expert.

Question 19

What does Dr. Guida say about consultations?

Accepted Answer

Dr. Guida uses real patient photos to discuss Tip Rhinoplasty surgery.

Question 20

What does Dr. Guida say about recovery?

Accepted Answer

Dr. Guida recommends hypoallergenic medical grade paper tape.

Dr. Robert A. Guida, MD

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